Provider Demographics
NPI:1922052752
Name:HAVEN HEALTH CLINICS
Entity Type:Organization
Organization Name:HAVEN HEALTH CLINICS
Other - Org Name:TEXAS PANHANDLE FAMILY PLANNING AND HEALTH CENTERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:CAROLENA
Authorized Official - Middle Name:S
Authorized Official - Last Name:COGDILL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:806-242-1565
Mailing Address - Street 1:1 MEDICAL DR
Mailing Address - Street 2:
Mailing Address - City:AMARILLO
Mailing Address - State:TX
Mailing Address - Zip Code:79106-4137
Mailing Address - Country:US
Mailing Address - Phone:806-322-3599
Mailing Address - Fax:806-372-5237
Practice Address - Street 1:1 MEDICAL DR
Practice Address - Street 2:
Practice Address - City:AMARILLO
Practice Address - State:TX
Practice Address - Zip Code:79106-4137
Practice Address - Country:US
Practice Address - Phone:806-322-3599
Practice Address - Fax:806-372-5237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207V00000X
TX564160363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1076010Medicaid